ATRESIA DUODENUM

EPIDEMIOLOGI
• Incidence of duodenal atresia: 1 per 5000 - 10,000 births.
• The highest incidence of duodenal atresia compared to other
duodenal obstruction abnormalities: duodenal atresia 40-60%,
duodenal web 35-45%, anular pancreas 10-30%, duodenal stenosis 7-
20%
• About half of babies born with duodenal obstruction have congenital
abnormalities of other organ systems
ETIOLOGY
• The underlying cause is unknown
• There are no maternal risk factors as predisposing to date
• About one third of patients with duodenal atresia suffer from trisomy
21 (Down syndrome), but this is not an independent risk factor in the
development of duodenal atresia
PATHOPHYSIOLOGY
• Inadequate endodermal proliferation (gastrointestinal elongation
exceeds its proliferation)
• Failure of epithelial solid band recanalization (failure of vacuolization
process)
• Occasionally, duodenal atresia is related to the anular pancreas
(pancreatic tissue surrounding the duodenum). This seems more due
to disruption of duodenal development than an excessive
development of pancreatic buds
DIAGNOSIS
• Clinical Symptoms
• Onset of vomiting in the first few hours after birth• Abdominal distention
does not occur frequently and is confined to the upper abdomen
• Dehydration and electrolyte imbalance
• Weight loss
• Jaundice is seen in 40% of patients, thought to be due to increased
enterohepatic recirculation of bilirubin
• History of pregnancy with polyhydramnios complications and infants with
Down syndrome should be suspected of suffering from duodenal atresia
• Supporting Examination: Abdominal X-Ray
• Description of two shadows of air bubbles (double bubble): bubble of the
stomach and proximal duodenal atresia
• Differential Diagnosis
1) Duodenal Web
• Double bubble image + small distal air bubbles
• Gastric and duodenal radiography examination with visible contrasts of the stomach,
proximal duodenum, and distal duodenum in the part where the obstruction is dilated.
Contrast appears to stop in the distal part and contrast is seen in the distal part of the
obstruction (Windsock appearance)
2) Anular pancreas
• Often found accidentally during surgery.
• Plain anular pancreatic pancreas, a double bubble sign that is a proximal dilatation of the
stomach and duodenum with no air in the distal part
• Diagnosis is based on imaging such as Multislice Computed Tomography (MSCT),
Magnetic Resonance Imaging (MRI), Magnetic Resonance Cholangiopancreatography
(MCRP), or Endoscopic Retrogade Cholangiopancreatography (ERCP)
3) Midgut Volvulus
• In plain abdominal radiographs, a double-bubble sign is seen which is a proximal
dilatation of the stomach and duodenum with the air at the distal part.
• The ultrasound shows a picture of the intestine entangling the arteries and superior
mesenteric veins
• On a CT-abdominal examination a whirl sign is found
• The EGDR check was found on the corkscrew sign.
TREATMENT
• Pre Surgery
• The act of decompression with the installation of a gastric tube (NGT) and suctioning of
liquid and air
• Liquid and electrolyte resuscitation, acid-base correction, hyponatremia and
hypokalemia need special attention
• Elective surgery the following morning
• Surgery
• The duodenoduodenostomy action through an incision in the right upper quadrant,
• Can also be performed for duodenoyeyunostomy anastomosis surgery
• No resection of the atresia, because ampulla vateri and Wirsungi can occur.
COMPLICATION
• After surgery, further complications can occur such as duodenal
swelling (megaduodenum), intestinal motility disorders, or
gastroesophageal reflux
PROGNOSIS
• With advances in the fields of pediatric anesthesia, neonatology, and
surgical techniques, the cure rate has increased to 90%
• Mortality is generally associated with other anomaly abnormalities
experienced specifically by infants with Trisomy 21 and abnormalities
of the heart complex
• Other factors that influence mortality rates: prematurity, low birth
weight and late diagnosis